Suck it up, America - ER Doc hits nail on head

thegreypilgrim

thegreypilgrim

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In an excerpt from his book Suck it up, America: The Tough Choices Needed for Real Health-Care Reform published in the Pittsburgh Post-Gazette Dr. Thomas Doyle (an ED physician in Sewickley, PA) cuts through the nonsense with sardonic precision, and outlines the real problem with healthcare in America.
 
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Hear Hear... I love the idea of "if you are not sicker than me, you can't come into the ambulance" I actually worked one shift with a broken toe (a full code in the back of the ambo surfing on the Interstate) and had to take a guy with a sore heel to the ED :glare:
 
Very well put. I think I'll end up buying his book because now I'm super curious on the rest of his thoughts.
 
Sounds good.



The woman who took us students on a tour during our clinical said they had a girl come into the ER one Christmas morning to take care of a wart that she had had for 7 months. lol.
 
I emailed him my idea..

Make the ER's huge, triage well and have resources to handle non-urgent emergencies; allow EMS to go to non-urgent centers instead of ER's if obviously appropriate.
 
mycrofft said:
Make the ER's huge, triage well and have resources to handle non-urgent emergencies; allow EMS to go to non-urgent centers instead of ER's if obviously appropriate.
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it doesn't remedy abuse, just switches where the abuse goes.
 
firecoins said:
it doesn't remedy abuse, just switches where the abuse goes.
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depends on how you define it. If our role is Emergency medical then it is abuse. If we realize that a large part of our community uses the ED and thus EMS as a primary care facility, then expanded scope (or perhaps a new technician altogether) can start a triage process and take patients to non-emergent facilities.
 
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Kaisu said:
depends on how you define it. If our role is Emergency medical then it is abuse. If we realize that a large part of our community uses the ED and thus EMS as a primary care facility, then expanded scope (or perhaps a new technician altogether) can start a triage process and take patients to non-emergent facilities.
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My health care system is a bit more widely available (and much, much cheaper) that that of the United States, so that definitely influences my opinion, which is as follows:


Emergency Room/Department = a room or department for EMERGENCIES. There should be no extremely large ERs with extremely proactive triaging. If you have an emergency, go to the emergency room. If you have a non-emergent something-or-other hypochondriac-minded illness, make an appointment with your friggin' general physician and if it happens to be worth the time and money invested in your care, (s)he will refer you to a specialist where it will be dealt with in a more appropriate manner. The hospital should NOT be responsible for transporting a "patient" with a hang over to a non-emergent facility. That only costs more money to the health care system. Exactly as it was said, "suck it up". Take a cab. Get a friend to drive you. Drive yourself. Hell, if you're so concerned about money just grab a pair of shoes and maybe even a bike --- but wait! The "patient" will go see the doctor about the sore muscles from a miniscule amount of exercise he/she has gotten.

And I can already tell I'm somewhat all over the place in my mini-rant. I didn't just wake up with a hang over.;)

Maybe I should go to the hospital for this hangover....:ph34r:
 
nomofica said:
My health care system is a bit more widely available (and much, much cheaper) that that of the United States, so that definitely influences my opinion, which is as follows:


Emergency Room/Department = a room or department for EMERGENCIES. There should be no extremely large ERs with extremely proactive triaging. If you have an emergency, go to the emergency room. If you have a non-emergent something-or-other hypochondriac-minded illness, make an appointment with your friggin' general physician and if it happens to be worth the time and money invested in your care, (s)he will refer you to a specialist where it will be dealt with in a more appropriate manner. The hospital should NOT be responsible for transporting a "patient" with a hang over to a non-emergent facility. That only costs more money to the health care system. Exactly as it was said, "suck it up". Take a cab. Get a friend to drive you. Drive yourself. Hell, if you're so concerned about money just grab a pair of shoes and maybe even a bike --- but wait! The "patient" will go see the doctor about the sore muscles from a miniscule amount of exercise he/she has gotten.

And I can already tell I'm somewhat all over the place in my mini-rant. I didn't just wake up with a hang over.;)

Maybe I should go to the hospital for this hangover....:ph34r:
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With the current health care system, many people can't afford insurance. Without insurance, they can't afford to have a general physician, hence why many people go to the emergency room.

Often they also can't tell what may be emergent and what may not be. They may also not know the capabilities of an urgent care clinic that could take care of things like broken bones or things needing stitches.

We need to educate our public and we need to reform.
 
Sasha said:
With the current health care system, many people can't afford insurance. Without insurance, they can't afford to have a general physician, hence why many people go to the emergency room.

Often they also can't tell what may be emergent and what may not be. They may also not know the capabilities of an urgent care clinic that could take care of things like broken bones or things needing stitches.

We need to educate our public and we need to reform.
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sasha is right.....people go to the emergency room either because they sense they are having an emergency, or they can't afford a primary physician.
 
amberdt03 said:
sasha is right.....people go to the emergency room either because they sense they are having an emergency, or they can't afford a primary physician.
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Right. The ER is more expensive, but you can A) Pay over time or B) Ignore the bill completely and they still wont turn you away the next time you come, unlike a doctor where you often pay up front for services and they can refuse to see you if you have an outstanding balance.
 
great article
 
Paradigm shift needed.

Anything which "emerges" is an emergency. They are triaged along a continuum of urgency. Instead of the "ER" being a small triage and as large a treatment area as possible, you need to apply crowd control measures and quit fighting the reality... get as large a TRIAGE corps as possible, then stringently sort and direct cases for treatment. The current mentality is to treat the ED as an unfortunate stepchild. Abolish it as we know it; if you are ready for the toothaches and hangnails then they aren't abusers, they are just people looking for medical care, however urgent, from zero to oh-oh.

Grocery stores felt people who wanted into tyheir stores at nght were bothersome, and locked them out while restocking etc. 7-11, QUik-Stop, and AM/PM opened up for them and out-expanded many grocery chains.
 
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Sasha said:
Right. The ER is more expensive, but you can A) Pay over time or B) Ignore the bill completely and they still wont turn you away the next time you come, unlike a doctor where you often pay up front for services and they can refuse to see you if you have an outstanding balance.
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yeah....i'll have to admit that i've used the er for something that i should have gone to a primary dr for.......all has to do with not having insurance.....i can say that i did pay my bill at least.
 
Blame it on the Lawyers

You can't discuss health care reform unless you are willing to discuss Tort reform!

Doctors can't send the cry babies, hypochondriacs home without fear of getting sued. Instead they have to cover their a$$ and run a bunch of unnecessary tests.

There should be limits on awards. It should be mandatory for plaintiffs to pay for the defendants legal expenses if they file a frivolous law suit and the lawyers who file the frivolous law suits should be disbarred.

EMS should be able to refuse patients. Based on our assessment, your condition is not an emergency and does not require ambulance transport. If you are that concerned, feel free to make an appointment with a private doctor or go to the "Doc'n'the box.

Just my opinion. If I was so smart, I would have gone to Law school instead of Paramedic school! ;-D
 
amberdt03 said:
sasha is right.....people go to the emergency room either because they sense they are having an emergency, or they can't afford a primary physician.
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Making the effort long before something becomes an emergency would cut down on ER over usage. There are minimal to no cost services for mental, pharmacy and health care in all 50 states whether a person is legally here or not. I've actually had quite a few people tell me they are advised to call an ambulance by "friends" so they don't have to wait in the waiting room. It isn't a coincidence they were all welfare or freebie cases. Diagnosis? Good ole entitlement syndrome.
 
rescue99 said:
Making the effort long before something becomes an emergency would cut down on ER over usage. There are minimal to no cost services for mental, pharmacy and health care in all 50 states whether a person is legally here or not. I've actually had quite a few people tell me they are advised to call an ambulance by "friends" so they don't have to wait in the waiting room. It isn't a coincidence they were all welfare or freebie cases. Diagnosis? Good ole entitlement syndrome.
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ummmm........if you don't have insurance health care and prescriptions aren't cheap.......well prescriptions are more affordable now with walmart's $4 plan. if you go to a dr's office without insurance, you have to pay up front before you can be seen......at a hospital you get seen and treated and then can leave without paying. i agree with you on if people make an effort to be seen before something becomes an emergency it would definitely cut down on er usage. But until something changes with our healthcare system, people who can't afford to see a primary dr, are going to continue to use the er as a dr's office.
 
amberdt03 said:
ummmm........if you don't have insurance health care and prescriptions aren't cheap.......well prescriptions are more affordable now with walmart's $4 plan. if you go to a dr's office without insurance, you have to pay up front before you can be seen......at a hospital you get seen and treated and then can leave without paying. i agree with you on if people make an effort to be seen before something becomes an emergency it would definitely cut down on er usage. But until something changes with our healthcare system, people who can't afford to see a primary dr, are going to continue to use the er as a dr's office.
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I don't agree. There are too many charity, state and county organizations to let well care go unchecked. True emergencies are a different story but, general stuff...there are county clinics open to even those who have insurance. It may not be convenient but it is cheap to free of charge depending on a person's ability. Urgent meds are free for peds (i.e. antibiotics) and 4 bucks for at least 100 of the most common medications at multiple pharmacy (chains) locations across the country. We're doing more than the average citizen is led to believe for our nations indigent population.
 
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